Dementia and falls

Lower-income seniors with dementia more likely to be admitted to hospital for falls

Seniors with dementia from lower-income neighbourhoods in Canada are more likely to visit hospitals for falls than those from more affluent areas, CIHI analysis shows.

It is well documented that seniors with dementia have a higher risk of falls in both long-term care and the community, compared with other seniors.Reference1 As a result, they are also more likely to visit emergency departments (EDs) for fall-related injuries and to be admitted to hospital.Reference2Reference3

Seniors with dementia in lower-income neighbourhoods are more disadvantaged: the rate of hospital admissions for falls is about 23% higher for these seniors compared with those living in high-income neighbourhoods. For this analysis, CIHI examined falls by 5 income levels; these were primarily determined based on average neighbourhood-level income, in line with analyses previously done in Canada. In general, seniors from lower-income neighbourhoods are more likely to visit the hospital for other health-related reasons (regardless of the presence of dementia). Lower socio-economic status is often correlated with negative health outcomes.Reference4

Our findings show that seniors with dementia consistently have higher rates of falls than seniors without dementia:

15%

of ED visits by seniors living with dementia are fall-related, compared with 9% among other seniors

“The reasons why people living with dementia are more likely to fall include having problems with mobility, balance and strength. They are prone to pacing, have trouble finding their way around and paying attention to hazards, and tend to walk too fast for their abilities. As well, they often are taking medications like antipsychotics that might make them drowsy, lower their blood pressure or cause problems with coordination. Like other older persons, they can have other risk factors for falling that may have nothing to do with their dementia,” said Dr. David Hogan, academic lead at the Brenda Strafford Centre on Aging, O’Brien Institute for Public Health, at the University of Calgary.

CIHI’s work with Accreditation Canada emphasizes the vital importance of preventing falls among seniors. Falls often result in hospitalization and surgery, increased physical dependence, long-term care admissions and death. The direct health care costs for fall-related injuries are $2 billion annually,Reference5 and the per capita cost is 3.7 times higher for Canadian seniors than for non-seniors.Reference6

Fall-related ED visits

Falls may lead to injuries and require a visit to the ED. 15% of ED visits by seniors with dementia are fall-related, compared with 9% by other seniors.

Seniors living with dementia have more fall-related ED visits

Proportion of ED visits due to falls, 2015–2016

Among seniors with and without dementia, fall-related visits are more common from long-term care. In addition, seniors with dementia have a higher proportion of ED visits related to falls compared with seniors without dementia, regardless of the setting.

Fall-related hospital admissions

Seniors are admitted to hospital when fall-related injuries are serious and require extensive treatment.

Seniors with dementia more frequently admitted to hospitals for fall-related injuries

Percentage of hospitalizations for fall-related injuries, 2015–2016

In 2015, seniors with dementia had more than 22,700 fall-related hospital admissions. For seniors living with dementia, 15.9% of all hospital admissions are fall-related, compared with 7.4% for seniors without dementia.

Fall-related hospitalization rates among all seniors vary by income, as highlighted in the report Trends in Income-Related Health Inequalities.Reference7 For seniors living with dementia, this income-related difference is also present. This disparity could be due to a number of reasons. Factors that affect fall risk vary and include (but are not limited to) types of medication, severity of the diseaseReference8 and the physical and social community environment.Reference9

“There is a variety of factors that might explain this disparity, but more work is required to fully understand what underlies it. Being from a wealthier neighbourhood could influence outside walkability, access to care, the adequacy of the dwelling and ability to afford modifications that would improve safety, or hiring help for supervision and assistance,” said Dr. Hogan.

Falls in long-term care

The proportion of seniors with dementia in long-term care or nursing homes who’d fallen in the past 30 days was 1.5 times higher than the proportion of seniors without dementia. In Ontario, Alberta and British Columbia, there was moderate variation in falls over the 5 years 2011 to 2015, with a slight increase (less than 2 percentage points) in fall rates among all senior residents, particularly in Ontario and Alberta.

Seniors living with dementia in long-term care more likely to fall

Proportion of seniors with dementia who fell in the last 30 days in long-term care (unadjusted rates)

16% of seniors living with dementia fell, compared with 11% of residents without dementia.

Falls in the home

For seniors who receive home care services, about 39% with dementia had a fall in the 90 days before their assessment, similar to the percentage of seniors without dementia (37%). More men with dementia who received home care fell (42%) than women (37%). There was large provincial variation in the percentage of home care clients with dementia with a record of falls. Ontario and B.C. reported that 40% fell, while Alberta reported that about 30% fell. These percentages represent unadjusted rates. Targeting fall prevention programs and safe practices to those receiving home care services should be a priority due to the high rates of falls.

What can be done?

In Canada, national and provincial organizations undertake efforts to reduce falls by seniors. For example, the Canadian Patient Safety Institute’s Safer Healthcare Now! implemented the Reducing Falls and Injuries From Falls Intervention.

The Falls Prevention/Injury Reduction Getting Started Kit, a guide to help professionals working across health sectors implement falls prevention/injury reduction programs for people age 65 and older

A series of national patient safety webinars that disseminate emerging evidence and help stimulate knowledge transfer

A measurement system to assess progress toward improvement goals

“Things that might be done to decrease fall risk among those living with dementia include reviewing their medications and discontinuing, where possible, those that are associated with falling, ensuring a safe environment, and optimizing physical fitness and strength through promoting activity and exercise. However, management can get complicated. For example, their impaired thinking might make the proper use of a cane or a walker difficult — in fact, it may increase the risk of trips and falls. More work is needed to identify the best approaches of minimizing the risk of falling among this group of seniors,” said Dr. Hogan.